Seismic shift needed in maternity services, says top midwife

A seismic shift is needed in maternity services to encourage women to feel better about giving birth at home, the general secretary of the Royal College of Midwives has said in a New Year’s Message.

A seismic shift is needed in maternity services to encourage women to feel better about giving birth at home, the general secretary of the Royal College of Midwives has said in a New Year’s Message.

Cathy Warwick, general secretary of the Royal College of Midwives, said she felt let-down by the Coalition Government’s pledge to increase midwife numbers and added that there had been "a concerted backlash" against homebirth and midwife-led care", with risk being overemphasised. This led women to think home births were unsafe.

“Home birth is as safe as a hospital birth for low-risk women when well-staffed maternity services are available," she said.

“The previous Government guaranteed that women in England will have a choice of where they want to give birth by the end of 2009. Twelve months later, we are not sure what the coalition Goverment’s position is on homebirth or whether they are honouring their pre-election promises for adequately staffed maternity services for 3,000 more midwives. We want to make sure that all women know that the choice of a home birth is available to them, and it is delivered for those women that want it.

“However, we feel that there is a concerted and calculated backlash by sectors of the establishment against homebirth and midwife-led care. There is a danger that risk during childbirth is presented in a way, which leads women to believe that hospital birth guarantees a safe birth – it does not; there is no evidence that a woman will have a safer birth in a hospital than at home.

To provide more homebirths, she said, required a total change in NHS maternity services with more midwives being recruited. “We are still embedded in a medicalised culture where the vast majority of births are in hospital and the caesarean section rate is a staggering 24.8 %. There also has to be a seismic shift in the number of midwives recruited and retained in 2011 because they are the people who will be providing home births," she said.

“Childbirth is a normal process not an ‘illness’ that requires hospitalisation. Homebirth should be supported by the medical establishment. The recently reported drop in the homebirth rate from 2.9 % in 2008 to 2.7% in 2009 is a real disappointment, particularly because the UK already has a very low rate compared to many other countries. We are not providing the choice of birth options that women want, need and deserve. Furthermore, NHS commissioners, who control the purse strings, are not doing enough to offer them that choice. There is a real need to look behind these homebirth figures to find out why our homebirth rate is so low and why it is falling. I worry that increasing pressures and demands on midwives and maternity services are being scapegoated to reduce mothers’ choices for maternity services.

She added that the change in improving access to homebirth had to start from the top. She said: "We are deeply disappointed that the Coalition Government has failed to commit to its pre-election promise to recruit 3,000 more midwives in the NHS in England. Politicians need to honour their promises, especially those made before elections. Choice of maternity services for women is not the only issue. Babies will be put at risk if midwives and maternity services cannot address health inequalities and tackle the challenge of maternal obesity. The inappropriate reorganisation of maternity services makes matters worse.

“I worry for the care of mothers and babies born in 2011 because the needs and concerns of pregnant women are greater than ever before and maternity services are stretched and almost near breaking point. I worry that quality of care will fall and that safety could be compromised. I worry that women and their babies will be ill served by maternity services.”